Payment based on authorized amount.
Code type
RARC (Remark)
Category
Medical Necessity
Common CARC pairings
RARC N45 appears with a Claim Adjustment Reason Code (CARC) on the 835 electronic remittance advice and gives more detail about the adjustment. These are the CARCs most often paired with RARC N45.
| CARC | Meaning |
|---|---|
| 50 | These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| 51 | These are non-covered services because this is a pre-existing condition. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| 119 | Benefit maximum for this time period or occurrence has been reached. |
| 150 | Payer deems the information submitted does not support this level of service. |
| 287 | Referral exceeded. |
See the full resolution workflow for RARC N45
Members of the EDI-Code Intelligence Lab get the step-by-step rework path, appeal language, root-cause drivers, and prevention checklist for every RARC and CARC pairing, plus payer-specific requirements.
Open in EDI Lab